1. C2ME Main findings Jeanine Suurmond, AMC, dept of Public Health, Project leader C2ME 18 September 2015 ‘Culturally Competent In Medical Education’ Amsterdam AMC/UvA With support from the EACEA Life Long Learning Programme

2. Social and cultural diversity in Europe Poorer health outcomes of care, particularly among minority populations Medical student population diverse Background C2ME Sociale Geneeskunde Background

3. National learning objectives for medical curricula Examples of learning objectives relating to diversity (bachelor level): -Knowledge of the meaning of socio-economic position, ethnicity, culture for the medical process (8.3.1.) -Skills to provide information in a way that is relevant and understandable for the patient (8.3.2.) -Professional behaviour: ability to obtain information from the perspective of the patient, characterized by an unbiased attitude, reflection on one’s own behaviour, respect. (8.3.3.) ‘Framework 2009’ (Raamplan)

4. Sociale Geneeskunde C2ME

5. Cultural competence Knowledge about social science concepts e.g. "culture" and "ethnicity"; Knowledge of how social/cultural factors can affect health(care); Knowledge about key patient population groups; Awareness of own norms, values and biases; Awareness of how culture shapes individual behavior and thinking; Ability to work effectively with an interpreter; Ability to identify and take into account socio-cultural factors that may influence patient care. Public Health Cultural competence

6. Cultural diversity included in curricula of many medical schools, but ….. 1. Lack of training of faculty members 2. Lack of organisational policy for structural implementation Background C2ME Sociale Geneeskunde Background

7. Sociale Geneeskunde Background “… training and evaluation of faculty and clinicians on cultural diversity issues are very important, since they serve as role models and their poor modelling may detract from work done in earlier years at medical schools” (Dogra et al., 2009, p. 992)

8. Sociale Geneeskunde C2ME Supported by the ERASMUS Lifelong Learning Programme of the EU (2013-2015) C2ME = Culturally Competent in Medical Education

9. Sociale Geneeskunde Who?

10. Sociale Geneeskunde Objectives C2ME 1.To develop, and implement Teach-the-Teacher modules on cultural diversity in the participating European countries 2.To develop and implement a policy for structural embedding of cultural competence training in medical schools

11. Sociale Geneeskunde C2ME activities 1.Develop TtT modules -Framework teaching skills: Delphi study -Teacher assessment (interest in training) -5 Pilot TtT courses & online modules 2.Develop policy for structural embedding cc in medical school -Assessment of policies in medical schools -Policy document (guidelines)

12. Sociale Geneeskunde DELPHI STUDY: Core teaching competencies KNOWLEDGE Knowledge of determinants of health ATTITUDES Awareness of own ethnic and cultural background Empathy for patients regardless of background Empathy for students of diverse background Awareness that teachers are role models SKILLS Ability to communicate about individuals in a non-stereotyping way Ability to engage, motivate and let participate all students Ability to critically reflect on own values and beliefs

13. Sociale Geneeskunde Teachers assessment -Survey bout preparedness to teach and interests in training (Likert scale 0-5) -43 items -“How prepared do you feel to….” -“How interested are you to receive training on…” -Among medical teachers at 12 participating universities N = 1103 (response rate: 20 %)

14. Sociale Geneeskunde Results (1) Preparedness to teach cultural competencies and teach diverse classroom: + Create a safe and open atmosphere when teaching + Engage, motivate and encourage participation of all students -Knowledge about disparities in health and care -How to address conflict in case of different cultural views patient and care provider -How to explore patient’s cultural/religious beliefs

15. Sociale Geneeskunde Results (2) Interest in receiving training is high + How to prepare students to adapt their communication style to respond to patient’s needs and capabilities + How to address conflict in case of different cultural views patient and care provider + How to explore students' own perspectives and values and reflect on how these may influence their future practice

16. Sociale Geneeskunde Conclusion Focus on training communication, e.g. how to address conflict when there are different cultural views between the care provider and the patient Other studies among smaller samples found comparable results (e.g. Rollins et al. 2013; Parker & McMillan 2008) Medical educators are in need of training in cultural competence training (Berger and Conroy, 2014; Lu et al. 2014), but what should overall goals of such training be? (see also review De Graaf et al. (submitted))

17. Thank you!

18. Sociale Geneeskunde More information  C2ME website: www.amc.nl/C2MEwww.amc.nl/C2ME  LinkedIn group (send us an email) J.Suurmond@amc.uva.nl